Introduction Tendon is a composite material with a well-ordered hierarchical structure exhibiting viscoelastic properties designed to transfer force. It is recognized that the incidence of tendon injury increases with age, suggesting a deterioration in homeostatic mechanisms or reparative processes. This review summarizes epigenetic mechanisms identified in ageing healthy tendon. Sources of data We searched multiple databases to produce a systematic review on the role of epigenetic mechanisms in tendon ageing. Areas of agreement Epigenetic mechanisms are important in predisposing ageing tendon to injury. Areas of controversy The relative importance of epigenetic mechanisms are unknown in terms of promoting healthy ageing. It is also unknown whether these changes represent protective mechanisms to function or predispose to pathology. Growing point Epigenetic markers in ageing tendon, which are under-researched including genome-wide chromatin accessibility, should be investigated. Areas timely for developing research Metanalysis through integration of multiple datasets and platforms will enable a holistic understanding of the epigenome in ageing and its relevance to disease.

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